Reevely: Opioid emergency prompts push for unapproved injection site

Ottawa Overdose Prevention volunteers, such as registered nurse and University of Ottawa professor Marilou Gagnon, spoke to media in front of the Human Rights Monument about the importance services like pop-up safe injection sites, in Ottawa on Aug. 24, 2017.David Kawai

Drug users are dying while politicians fill out forms and wait for approvals for supervised injection sites, says a group promising to open a guerrilla injection tent of its own somewhere in Ottawa Friday.

Overdose Prevention Ottawa, which has only existed for a matter of days, is taking the delicate political compromises that have let harm-reduction efforts lurch forward here and kicking them aside. Because waiting is costing lives, the group says.

The group has cautious support from Ottawa Public Health, which is resisting political pressure to shut its plans down.

Supervised injection sites are meant to be places where drug addicts can inject chemicals like heroin and have health workers available to react immediately if they overdose. Overdose Prevention Ottawa is pushing against a boulder that’s already moving a little: After years of opposition from the federal Conservatives when they were in government, the Liberals have approved several across Canada. One is due to be added to the Sandy Hill Community Health Centre soon but isn’t open yet.

“We force people to use alone. They don’t have a safe space in Ottawa,” said Marilou Gagnon, a nursing professor at the University of Ottawa and vocal advocate for the idea that drug users benefit more from safe drug supplies and access to nonjudgmental health workers than from prohibitions on their drugs.

Gagnon and other members of the group spoke at the Human Rights Monument, on the grounds of city hall at Elgin and Lisgar streets, as members of Mayor Jim Watson’s staff looked on from his office windows. Although Overdose Prevention Ottawa members plan to open their site in a tent somewhere downtown on Friday, they wouldn’t say where yet.

Unlike a full health clinic, Gagnon said, the group’s site will have volunteer health workers only to monitor drug users who inject there and respond to overdoses with naloxone, a drug that can reverse them. They’re crowdfunding to cover costs. It’s not meant to be a substitute for an emergency room or a community health clinic, just better than nothing. Because that rock is not shifting fast enough. People are dying.

“Six months? A low figure? Twenty five people,” said Robert Jamison, a former drug user who volunteers helping current drug users in and around Chinatown. That’s how many people he can personally name who’ve died of overdoses, he said. “It’s great that there are going to be these bigger sites, I’m all for that, but we can’t wait any longer. We don’t have the luxury.”

Fentanyl and carfentanil, massively potent opioids that are easier to smuggle than heroin or morphine, are being cut into the street drugs available in Ottawa. They’re killing users who have to take what they can get and end up injecting much more powerful drugs than they expect. Ottawa Public Health has begun releasing regular statistics on overdoses and the report for June shows that 135 people were taken to emergency rooms here in that month, the highest number in two-and-a-half years.

“We had two years. I’ve been going around with my fellow outreach workers for two years, warning that this is going to hit. And now it’s here. We’ve had a lot of time to prep for this and we didn’t,” Jamison said. So he’s burying friends, administering naloxone, even going into an apartment where a mother had overdosed and died while her baby slept.

The governments’ talk is nice, he said, but so far just talk.

“Alls I can relate to is what my last 30 days on my little block have been like,” Jamison said. “I’m not seeing these words on my block.”

Similar groups in Toronto and Vancouver have opened “pop-up” injection sites that Overdose Prevention Ottawa considers good models.

Vancouver has seen 232 lethal overdoses so far this year, twice as many as in all of 2016. There, tiny injection sites have been given official sanction from the provincial government as part of an emergency response to an epidemic. Toronto’s pop-up injection site opened earlier this month and has been tolerated by authorities there, though Toronto’s public-health unit also just opened a stripped-down version of a full supervised injection site that was due to open later this year anyway.

Ottawa’s chief medical officer of health, Dr. Isra Levy, supports supervised injection sites. Earlier this year, he convinced the board of health that oversees the unit to support them, too — in general terms, subject to community consultations, run by experts in places like community health centres.

That’s been the compromise route through a political situation that has many local leaders, including the mayor, rhetorically opposing safe injection sites but willing to stand down as long as they’re not asked to vote for them directly. They look elsewhere while the health unit runs needle exchanges and tells drug users not to use alone and to have naloxone kits (distributed free by pharmacies, funded by the province) on hand.

The pop-up plan upends that compromise.

College Coun. Rick Chiarelli wrote Levy a letter Thursday demanding what he’d do to intervene.

“Some have drifted into the believe (sic) that if they don’t like a law or legal requirements they can just ignore it all. It is not ok, and a danger to the public, to put up an unlicensed medical facility just because it is inconvenient to do all the paperwork,” Chiarelli wrote. “Please advise me as quickly as possible regarding the steps that will be taken to prevent this from happening.”

He compared the activists’ planned tent to an unlicensed plastic-surgery joint that the health unit closed in his ward. “We shut that down, but only after residents had been permanently disfigured. When dealing with opioids the consequences can be even worse than disfigurement. What happens if someone dies? Who is liable?” Chiarelli wrote.

The health unit won’t charge in, Levy replied, in writing. Though the details are still scant, he wrote, the plan sounds more like a form of peer support than a medical intervention, and that means the health unit can (cautiously) support it.

“I have asked members of my team to reach out expeditiously to individuals associated with this initiative to offer assistance in ensuring responsible and high quality peer support, aligned with the work being done by (Ottawa Public Health) ‎and our partners in the community,” Levy wrote.

Somerset Coun. Catherine McKenney, who is a member of the health board, clenched her teeth at Chiarelli’s analogy in an interview.

“People don’t die from lack of plastic surgery,” she said. “People do die if they’re not being supervised using opioids.”

McKenney agreed that the cumbersome process for opening a legal injection site has taken much too long. She would prefer to see a response more like Toronto’s, with the health unit setting up its own quick supervised site or supplying nurses whose drug-treatment qualifications are beyond question, she said, but she understands the urgency.

“There are people who are seeing their friends, their kids, their family members dying of preventable overdoses and they want to take immediate action,” she said.

A group of activists say they’re planning to open an unsanctioned “pop up” drug injection site in Ottawa to combat the city’s overdose problem.David Kawai

David Gibson, the executive director of the Sandy Hill Community Health Centre here, said in a phone interview that his clinic’s supervised site is due to open in late October or early November. The provincial government has approved its floor plan and the centre is finalizing its budget. It has indeed been a slog, he said.

“From my standpoint, I totally appreciate the frustration. It took us five years to get to where we’ve got and that’s only because of change in federal government. The intention to save a life and prevent an overdose is one I totally support,” he said.

Gibson worries mainly about the people manning the pop-up.

“They are putting themselves in a tight position vis-à-vis enforcement, because they are not sanctioned,” he said. “And as well, in the event that there is a medical issue that is beyond their scope. And that’s the difference in terms of the formalized process with Health Canada … What we have at Sandy Hill Community Health Centre is we have the capacity to deal with those emergencies beyond just an OD and giving naloxone.”

Jill Skinner, a deputy chief of the Ottawa police, watched the news conference wearing civvies and sunglasses. She’d just heard about the pop-up plan earlier Thursday, she said, and had rushed to research the models it’s copying. Her immediate reaction was careful, though she implied that the police will wait to see how the pop-up works before deciding whether there’s anything that needs busting.

“We’ve been saying all along, ‘This is a public health issue.’ We want to ensure public safety,” Skinner said. “What we’ve seen in Vancouver and Toronto is they’ve put a professional process in place to see as much public safety as possible, and that’s all we want. … We are not the United States, we do not arrest people who overdose, we get them medical attention.”

The health unit will have to deal with the public-health implications, Skinner said.

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Mayor Jim Watson seems well-rested after recovering from appendicitis. In my interview with him this week, he admitted he couldn’t resist keeping his BlackBerry by his side while keeping a low profile (I guess that
).